Rural San Angelo, Texas, is home to Fort Concho, one of the best preserved frontier forts in the West, and its river yields freshwater pearls, boasts private practitioner Rick McGraw, PhD, of his adopted hometown. Another interesting fact: San Angelo is three hours from the Mexico border--with only one service station the last hour and a half.
But, at a time when many psychologists are looking for ways to attract more clients and market their practices, they might find this fact most alluring: "I could easily put five psychologists to work full time if I could get them to move here," McGraw says.
The region especially needs services for the elderly. "Rural populations are getting older, and there is a great need for geropsychology expertise," he says, adding that funding is available to do so through Medicare or Medicaid.
Typical problems with the rural elderly include depression or anxiety disorders brought on by chronic illness and isolation, he says. "Many of them have outlived everyone, and their support system is growing smaller and smaller in terms of people they can rely on," he says, adding, "Nursing homes are calling me weekly."
To maximize the services of the mental health professionals who are available, McGraw and his wife, psychologist Lee Lynn Morrison, PhD, lead a program they imported from Houston called Senior Connections. The program sends psychologist-led teams of three to five mental health professionals into San Angelo nursing homes. Two or three days each week, the teams provide one-on-one counseling to the residents and educate the staff about warning signs for mental health problems.
"Through this program, we begin to change the consciousness in the facility in terms of how to think about mental health problems," says McGraw.
A native Texan, McGraw earned his doctorate at the University of North Texas with a scholarship from the U.S. Air Force and returned to San Angelo--where he had been stationed before graduate school--to launch his practice. Many of his clients are referred to him by priests, pastors or primary-care physicians and travel an average of 90 miles from the surrounding frontier counties to see him. Latinos make up much of his client base and roughly one third of the region's population, making cultural competence an important factor. McGraw, who is half-Latino--his Hispanic mother was born in the border town of Eagle Pass, Texas--speaks proficient, but not fluent Spanish, which he refers to as "Tex Mex."
"If a person also speaks some English, then I can usually make it work," he says.
Living in rural Texas hasn't isolated McGraw; in fact, it has spurred him to join in state and national advocacy. McGraw is a past-president of the Texas Psychological Association, a member of APA's Committee on Rural Health, past-president of the Psychological Association of Greater West Texas, a former APA federal advocacy coordinator for Texas and recipient of a Karl F. Heiser award for professional advocacy from APA in 2000. His aim is to spread the word about the need for more rural providers and research on rural mental health.
"I go in there with the attitude of 'Don't forget that we have other types of constituents besides urban psychologists and their patients,'" he says. "I am trying to make a difference in how people think about how psychology is utilized and implemented in a rural community."
McGraw is also a strong supporter of prescription privileges in Texas and predicts that the rural need will facilitate its passage in the state, and hopefully, draw more psychologists to rural areas.
In the meantime, he encourages students and new professionals to consider courses, continuing education and postdocs in rural collaborative care, health psychology, geropsychology and psychopharmacology to take advantage of "a tremendous opportunity to contribute to and lead the evolution of the rural health-care delivery system," he says.